Black Blood Research Articles

No Rheum at The Insula: Rheumatoid Lepto-meningitis as Cause of Focal Seizure (P9-5.023)

<h3>Objective:</h3> NA <h3>Background:</h3> Patient is a 65 year old female with history of rheumatoid arthritis, MGUS, SJogrens disease, CAD, aortic aneurysm with dissection; who presented with recurrent episodes of leg weakness and shaking. Initial symptoms began 1 month prior to presentation, with interim progression and increasing frequency. The symptoms would start without prodrome, involve uncontrollable movements, and could last several hours prior to spontaneous resolution. <h3>Design/Methods:</h3> NA <h3>Results:</h3> Neurologic exam revealed LLE hyperreflexia with upgoing babinski and was otherwise normal. Initial differential included stroke with subsequent epileptogenic focus, transverse myelitis, methotrexate toxicity, Behcets, infectious process, and atlantoaxial subluxation. MRI of the spine without evidence of disease. MRI brain showed leptomeningeal enhancement of the right frontoparietal vertex, with MRA showing multifocal hyperintensities with wall irregularities concerning for CNS vasculitis. Lumbar puncture and MR black blood imaging was performed, along with vasculitis workup. MR black blood returned with continued concerns for vasculitis. Lumbar puncture showed 22 wbc, with xanthochromia, normal protein. Rheumatologic workup with Complement levels and SPEP were all reassuring, with only minimal elevation of CRP at 10.4 and ESR 31. Infectious work-up, including for opportunistic infections, was negative. Neurosurgery was consulted for biopsy which was positive for amyloid angiopathy, with rheumatology indicating probable diagnosis of rheumatoid-associated vasculitis. While in the hospital, the patient was witnessed to have an episode of her presenting symptoms of left leg shaking which was observed to be rhythmic and non-distractible. Routine EEG, showed no evidence of epileptiform activities, however the patient was treated with levetiracetam without return of her symptomatology. <h3>Conclusions:</h3> Rheumatoid arthritis is a known systemic disease that can potentially and rarely affect other organs including the CNS. In this case, the patient presented with focal seizures secondary to cortical irritation caused by leptomeningeal enhancements of her right hemisphere. <b>Disclosure:</b> Dr. Elhassan has nothing to disclose.

Cerebral amyloid angiopathy-related inflammation (CAARI) and HHV-6 positivity: A case report of a treatment dilemma and a possible relationship (P1-12.003)

<h3>Objective:</h3> To examine the treatment dilemma utilizing high-dose steroids in a patient with cerebral amyloid angiopathy-related inflammation (CAARI) and HHV-6 positivity. Additionally, to question a possible relationship between HHV-6 and CAARI. <h3>Background:</h3> Cerebral amyloid angiopathy-related inflammation (CAARI) has been described as a distinct syndrome with subacute cognitive decline or seizure symptoms. Previous studies have established diagnostic criteria for this entity and proposed a treatment strategy. However, the precipitating factors behind developing CAARI in a subset of patients with CAA are unclear. We present a case of CAARI in a patient with no underlying diagnosis of dementia that was found to be positive for HHV-6 in serum and CSF and treated successfully with steroids. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> An 83-year-old woman presented with a first-time generalized tonic-clonic seizure with postictal confusion. On presentation, her systolic blood pressure was elevated at 150–170, and she was tachycardic to 160 with a temperature of 38.4. A contrasted MRI brain showed multifocal vasogenic edema, sulcal FLAIR hyperintensity, and innumerable lobar microhemorrhages. Black blood contrast MRI brain angiogram was unremarkable, with no evidence of vasculitis. At this point, the patient had clinically improved but remained slightly encephalopathic with word-finding difficulties. Continuous EEG monitoring showed diffuse background slowing. Initial CSF studies revealed an isolated mildly elevated protein of 49 and negative cytology. Therefore, based on the clinical and radiographic evidence, a decision was made to undergo five days of high-dose methylprednisolone for probable CAARI. However, days later, HHV-6 in CSF resulted positive with 249 copies/ml, and a serum sample showed 1100 copies/ml. <h3>Conclusions:</h3> The concurrence of cerebral amyloid angiopathy-related inflammation (CAARI) and HHV-6 in serum and CSF might yield a diagnostic and therapeutic challenge. However, the treatment with high-dose pulsatile steroids with taper did improve the overall clinical picture. Further studies are needed to investigate a potential correlation. <b>Disclosure:</b> Dr. Alshawa has nothing to disclose. Dr. Makkieh has nothing to disclose. Miss Alsakka has nothing to disclose. Dr. Torres-Melendez has nothing to disclose.

Visualizing Cerebral Small Vessel Degeneration During Aging and Diseases Using Magnetic Resonance Imaging.

Cerebral small vessel disease is a major contributor to brain disorders in older adults. It is associated with a much higher risk of stroke and dementia. Due to a lack of clinical and fluid biomarkers, diagnosing and grading small vessel disease are highly dependent on magnetic resonance imaging. In the past, researchers mostly used brain parenchymal imaging markers to represent small vessel damage, but the relationships between these surrogate markers and small vessel pathologies are complex. Recent progress in high-resolution magnetic resonance imaging methods, including time-of-flight MR angiography, phase-contrast MR angiography, black blood vessel wall imaging, susceptibility-weighted imaging, and contrast-enhanced methods, allow for direct visualization of cerebral small vessel structures. They could be powerful tools for understanding aging-related small vessel degeneration and improving disease diagnosis and treatment. This article will review progress in these imaging techniques and their application in aging and disease studies. Some challenges and future directions are also discussed. EVIDENCE LEVEL: 4. TECHNICAL EFFICACY: 3.

The Nightmare Island: Representations of St. Barthélemy in Swedish Novels

The Nightmare Island: Representations of St. Barthélemy in Swedish Novels

High-efficiency 3D black-blood thoracic aorta imaging with patch-based low-rank tensor reconstruction.

Three-dimensional (3D) black-blood (BB) vessel wall imaging is a promising noninvasive imaging technique for assessing thoracic aortic diseases. We aimed to develop and evaluate a fast thoracic aorta vessel wall imaging method with patch-based low-rank tensor (Pt-LRT) reconstruction using the 3D-modulated variable flip angle fast-spin echo (vFA-FSE) sequence. The Pt-LRT technique adopts a low-rank tensor image model with regularization to explore the local low-rankness and nonlocal redundancies of the images to assess the thoracic aorta vessel wall. It uses high-order tensors to capture correlations between data in multiple dimensions and reconstructs images from highly undersampled data. For this study, 12 healthy participants and 2 patients with thoracic aortic diseases were evaluated at 3T magnetic resonance (MR). The reconstruction results were compared to the traditional generalized autocalibrating partially parallel acquisitions (GRAPPA) and ℓ1-SPIRiT reconstruction to assess the feasibility of the proposed framework. Quantitative analyses of the vessel wall thickness (VWT), internal diameter (ID), lumen area (LA), and contrast-to-noise ratio (CNR) between the lumen and vessel wall were performed on all healthy participants. Results demonstrated no significant differences between the GRAPPA and the proposed Pt-LRT in VWT, ID, or LA of the aorta (P<0.05). A higher mean CNR was attained with 3D patch-based low-rank tensor reconstruction than with ℓ1-SPIRiT reconstruction (49.4±10.8 vs. 38.9±8.2). The proposed 3D BB thoracic aorta vessel wall imaging method can reduce the scan time and produce an image quality that is in good agreement with the conventional GRAPPA acquisition, which takes approximately more than 8 min. This study also shows that the proposed Pt-LRT method substantially improves the visualization and sharpness of the vessel wall and the definition of the tissue boundary compared to the imaging obtained with ℓ1-SPIRiT.

Quantitative evaluation for intravascular structures of vertebral artery dissection with a novel zoomed high-resolution black-blood MR imaging.

Although non-stroke vertebral artery dissection (VAD) is diagnosed using MRI, detecting the subtle intravascular structure remains challenging. This study aimed to evaluate the validity of quantitative intravascular scanning based on novel zoomed high-resolution black blood (Z-HB) MRI for distinguishing VAD from other vessel pathologies. Twenty-one patients with non-stroke VAD and 18 with symptomatic atherosclerotic plaques in their vertebral artery underwent Z-HB MRI and subsequent profile curve processing. Axial Z-HB imaging was obtained from dissected and normal segments in patients with VAD and atherosclerotic plaque in patients with ischemia. We investigated the qualitative categorization of the scanning patterns of the intravascular signals. We also evaluated the quantitative ability of each profile curve to discriminate multiple vessel pathologies by analyzing the receiver operating characteristics curves. Profile curve processing of 140 Z-HB images categorized the intravascular signal patterns into luminal, asymmetrical, and omega types. The asymmetrical type included both dissecting and atherosclerotic vessels, and the omega type included dissecting and normal vessels. In the asymmetrical type, quantitative evaluation successfully distinguished intramural hematomas of VAD from atherosclerotic plaque with an area under the curve of 0.80. The intimal flap of the VAD was distinguished from the blood flow artifact of the normal vessel with an area under the curve of 0.93 in the omega type. A combination of novel Z-HB MRI and profile curve processing provided an ultra-high-resolution analysis of the intravascular structure of non-stroke VAD and successfully distinguished VAD from normal vessels or atherosclerotic plaques.

On Being Hit: What stage of the pandemic is this?

On Being HitWhat stage of the pandemic is this? Jordan Kisner (bio) i have a friend who once made a habit out of getting hit. It is not hard to find a fight after midnight in a dive bar, but he was especially skilled at it. We'd be out late, playing pool or drinking beer and messing around like people in their twenties do. He would get a little drunk and he'd find some agitated-looking guy to find fault with, and he'd start to pick and pick. Eventually, things would come to blows, and he'd get punched in the face. I loved this man, who was as close to an older brother as I'd ever had. He was smart and handsome and sweet to me, darkly funny, and tender. He read people well—he read me well—and he had a habit of making jokes that were inappropriately bleak or inconveniently honest. His affection was comforting for its lack of [End Page 5] subtext. He never wanted anything from me, which was so often an undertone of being touched, even platonically, by men during those years. He never seemed to want me to be anything other than I was, either—never found fault with the parts of myself I struggled to accept. Maybe what I am saying is that he made me feel safe. But I had never been close to someone who made a habit of getting into physical fights, and I was baffled by it. Perhaps I should have been scared, and probably on some level I was scared, but his violence—what of it I saw—seemed blustery rather than dangerous, even boyish. Once, at a Halloween party, dressed like a pumpkin, he tried to start a fight. I put my body between him and the other man, trying to get him to hear my voice and look in my eyes, while another friend, dressed as Thoreau, tried to soothe the other guy. It worked for a while, but the night still ended with a black eye and blood on the pumpkin costume. I understood that he was angry, and that the anger came out sideways. I understood that there were legitimate reasons for him to feel pissed off at the world—though none feel like mine to share—and I understood that sometimes dislocation or alienation feels like a kind of violence you want to meet with violence. I understood how good it can feel sometimes to just let it rip. Still, this quality in him confused me. Once, we were hanging out with friends he was fond of and who were fond of him. There were no strangers in the bar. We were simply happy. As the night wore on, he started asking us to hit him. "Punch me in the face," he said to me, charming, cajoling. "Just punch me right here." "No," I said, rolling my eyes, smiling. "I'm not going to hit you." "Come on." He used my pet name. I was unnerved. He grabbed my hand and crumpled my fingers into a loose fist. "Just hit me once in the face." I laughed, and then I stopped. I kept telling him no: I wasn't going to hit him, I wasn't going to hurt him, even as a joke, even once. Eventually another friend, a poet, did it. She wound up and punched him right in the eye. I couldn't watch. Afterward, he thanked her and kissed her on the forehead. He seemed relieved, [End Page 6] and she seemed flushed and sort of proud: the punch she'd thrown was a serious one. The intimacy of it all unsettled me at the time: Why were they both pleased? What was this exchange? It occurred to me then that his habit of starting fights was not only about wanting to hit someone. Sometimes he just wanted to be hit. I've been thinking of this moment because someone asked me recently what kind of care people owe each other at this stage of the pandemic. I have no idea, I thought. What stage of the pandemic is this, exactly? I'm...

Abstract Number ‐ 234: Bilateral Non‐Painful Stimulus‐Induced Decerebrated Posturing In A Bilateral Pontine Ischemic Stroke: A Case Report

Introduction A 38 year‐old right‐handed female is a fully functional teacher with past medical history of hypertension, type II Diabetes Mellitus, polycystic ovarian syndrome, and infertility. She presented to our emergency department (ER) on the same day she was discharged twice from a local ER for acute onset persistent non‐fluctuating left‐sided weakness and painful bilateral leg spasms that woke her from sleep. Patient had pertinent exam findings of moderate pharyngeal dysarthria, mild right nasolabial flattening, mild weakness of left upper extremity (LUE), and stereotyped, painful tonic extensor posturing of the bilateral lower extremities associated with back arching and extensor response of bilateral toes. NIH Stroke Scale was 10. Methods We conducted a review of patient clinical documentation. Results MRI Brain showed anterior asymmetric bilateral pontine ischemic strokes at the ventral pontomedullary junction. MRA brain with black blood sequencing revealed multifocal vasculopathy at the right V4, mid‐basilar and left M1 segments. An angiogram showed Moya‐moya type collaterals. Tonic posturing and spasms persisted for several hours requiring muscle relaxants and benzodiazepines for symptomatic management. Unfortunately, the patient had worsening LUE weakness, inability to swallow and was found to have total vocal cord paralysis. She was intubated for airway protection and after failing extubation required tracheostomy and percutaneous gastrostomy placement. Initial workup revealed poorly controlled hyperlipidemia (LDL 162) and diabetes (A1c 8.7%), CRP 7–9, hypercoagulable panel and transthoracic echocardiogram were unremarkable. Lumbar puncture was also unremarkable (CSF TNC 2, RBC 3, glucose 116, protein 35, Enterovirus and HSV 1,2 PCR, Streptococcus antigen and VDRL were negative). Anticoagulation was started for an incidental right lower lobe subsegmental pulmonary embolism. Ultimately, the patient was discharged to inpatient rehabilitation (IPR) with a Modified Rankin Scale (mRS) of 4, on day 19th of hospitalization with some improvement in oral intake and decannulation of tracheostomy. Conclusions Movement disorders caused by strokes have been described in the literature. In their majority, they are secondary to a supratentorial injury. There have been some cases published of infratentorial, unilateral lesions that have caused different types of involuntary movements. More specifically, two papers described tonic spasms seen in pontine strokes. To our knowledge, this is a novel description of a case of bilateral pontine ischemic stroke that causes painful tonic spasms associated with decerebrate rigidity or posturing. Our hypothesis is that given the localization of the strokes in the anterior area of the inferior segment of the pons there may be involvement of the corticospinal, corticobulbar, and rubrospinal tracts which may be responsible for this presentation. Posterior circulation strokes can be missed about 9–14% of the time, possibly due to atypical presentations. We believe that presenting this case can help to improve the current available literature on this topic.

Strong Contrast Stagnation of Unilateral Vertebral Artery on Three-Dimensional Black Blood-Enhanced MRI Predicts Acute Medulla Infarction.

This study aimed to evaluate angiographic and contrast enhancement (CE) patterns on three-dimensional (3D) black blood (BB) contrast-enhanced MRI in patients with acute medulla infarction. From January 2020 to August 2021, we retrospectively analyzed stroke 3D BB contrast-enhanced magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) findings of patients visiting the emergency room for symptom evaluation of acute medulla infarction. In total, 28 patients with acute medulla infarction were enrolled in this study. Four types of 3D BB contrast-enhanced MRI and MRA were classified as follows: 1=unilateral contrast-enhanced vertebral artery (VA)+no visualization of VA on MRA; 2=unilateral enhanced VA+hypoplastic VA; 3=no enhanced VA+unilateral complete occlusion of VA; 4=no enhanced VA+normal VA (including hypoplasia) on MRA. Of the 28 patients with acute medulla infarction, 7 (25.0%) showed delayed positive findings after 24 hours on diffusion-weighted imaging (DWI). Of these patients, 19 (67.9%) showed CE of the unilateral VA on 3D BB contrast-enhanced MRI (type 1 and 2). Of the 19 patients with CE of VA on 3D BB contrast-enhanced MRI, 18 showed no visualization of enhanced VA on MRA (type 1), and 1 showed hypoplastic VA. Of the 7 patients with delayed positive findings on DWI, 5 showed CE of the unilateral VA and no visualization of the enhanced VA on MRA (type 1). Symptom onset to door time or initial MR check time was significantly shorter in the groups with delayed positive findings on DWI (P<0.05). Unilateral CE on 3D BB contrast-enhanced MRI and no visualization of the VA on MRA are related to the recent occlusion of the distal VA. These findings suggest that the recent occlusion of the distal VA is related to acute medulla infarction, including delayed visualization on DWI.

UR-CarA-Net: A Cascaded Framework With Uncertainty Regularization for Automated Segmentation of Carotid Arteries on Black Blood MR Images

We present a fully automated method for carotid artery (CA) outer wall segmentation in black blood MRI using partially annotated data and compare it to the state-of-the-art reference model. Our model was trained and tested on multicentric data of patients (106 and 23 patients, respectively) with a carotid plaque and was validated on different MR sequences (24 patients) as well as data that were acquired with MRI systems of a different vendor (34 patients). A 3D nnU-Net was trained on pre-contrast T1w turbo spin echo (TSE) MR images. A CA centerline sliding window approach was chosen to refine the nnU-Net segmentation using an additionally trained 2D U-Net to increase agreement with manual annotations. To improve segmentation performance in areas with semantically and visually challenging voxels, Monte-Carlo dropout was used. To increase generalizability, data were augmented with intensity transformations. Our method achieves state-of-the-art results yielding a Dice similarity coefficient (DSC) of 91.7% (interquartile range (IQR) 3.3%) and volumetric intraclass correlation (ICC) with ground truth of 0.90 on the development domain data and a DSC of 91.1% (IQR 7.2%) and volumetric ICC with ground truth of 0.83 on the external domain data outperforming top-ranked methods for open-source CA segmentation. The uncertainty-based approach increases the interpretability of the proposed method by providing an uncertainty map together with the segmentation.

Evaluation of Intra-Aneurysmal Residual Blood Flow with the iMSDE T1-Black Blood Imaging after Flow Diverter Treatment.

We aimed to evaluate the efficacy of the "improved motion-sensitized driven-equilibrium (iMSDE)"-prepared T1-weighted black blood (T1-BB) MRI for monitoring treatment effect with a flow diverter (FD) for cerebral aneurysms. Following the exclusion of concomitant coiling and retreatment cases from 60 consecutive cases of cerebral aneurysms treated with FDs at our institution, 32 with imaging data were included in the analysis. Detectability of residual blood flow within the aneurysms was validated as follows: 1) comparison of MRI sequences (iMSDE-prepared T1-BB images, T1-weighted images [ T1WI], and time-of-flight [ TOF]-MRA) in cases of incompletely occluded aneurysms and 2) comparison of angiography and MRI sequences in the same period. 1) The probability of diagnosing intra-aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB (iMSDE-prepared T1-BB vs. T1WI, p <0.001; iMSDE-prepared T1-BB vs. TOF-MRA, p <0.001). 2) The diagnostic accuracy of residual aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB than that with T1WI (p = 0.032). Furthermore, in cases of incomplete occlusion, the probability of detecting intra-aneurysmal blood flow was significantly higher with iMSDE-prepared T1-BB (iMSDE-prepared T1-BB vs. T1WI, p <0.001; iMSDE-prepared T1-BB vs. TOF-MRA, p = 0.023). Our results demonstrated that iMSDE-prepared T1-BB could help distinguish between blood flow and thrombus within the aneurysms after FD treatment, especially in the early stages of FD treatment.

Detecting immunoglobulin G4-related intracranial arteriopathy with magnetic resonance vessel wall imaging: a preliminary experience in two cases

BackgroundDetecting immunoglobulin G4 (IgG4)-related intracranial arteriopathy, a rare neurovascular complication of IgG4-related disease, is challenging. While magnetic resonance (MR) vessel wall imaging (VWI) can visualize various neurovascular pathologies, its application to this arteriopathy has not been reported as of this writing.Case presentationA 74-year-old male and a 65-year-old female manifested multiple cranial nerve palsy and neck pain, respectively. Both cases exhibited multiorgan masses with markedly elevated serum IgG4 levels and were clinically diagnosed with IgG4-related disease. Three-dimensional T1-weighted black blood VWI with and without contrast agent identified intracranial vascular lesions characterized as nearly-circumferential mural thickening with homogeneous contrast enhancement in the internal carotid and vertebral arteries; some of the lesions had been unrecognized with screening MR angiography due to expansive remodeling. The former patient underwent corticosteroid therapy, and VWI after treatment revealed decreased mural thickening and enhancement.ConclusionFurther studies to elucidate characteristic findings of VWI might contribute to early detection of this treatable pathology.

Prevalence and distribution of aortic plaque by sex and age group among community-dwelling adults

Rationale and objectivesAtherosclerosis of the aorta is associated with increased risk of cardiovascular mortality and vascular events. We aim to describe the prevalence and distribution of non-calcified atherosclerotic plaque in the descending aorta as quantified by noncontrast cardiovascular magnetic resonance (CMR) in a community-dwelling cohort of adults. Materials and methodsWe used CMR to quantify noncalcified aortic plaque in 1726 participants (aged 65 ± 9 years, 46.7% men) from the Cohort Study Offspring cohort. ECG-gated, fat-suppressed, T2-weighted, black blood turbo spin echo sequence was used to acquire 36 transverse slices covering the descending aorta from just below the arch to the aortoiliac bifurcation. Plaque was defined as discrete luminal protrusions ≥1 mm; these were manually traced, then summed to determine total descending aortic plaque (DAP) and segmental thoracic and abdominal aortic plaque (TAP, AAP). Participants were stratified by sex and age group (<55, 55–64, 65–74, ≥75y). A healthy referent group (without clinical cardiovascular disease, smoking, diabetes, impaired renal function; (N = 768, 43.8% men) was used to determine upper 90th percentile cutpoints for DAP and AAP which were then applied to the overall study cohort. ResultsPrevalence of DAP was similar between men (47.3%) and women (48.9%), p = 0.50, as was AAP prevalence (men: 44.5%, women: 46.7%, p = 0.16); TAP was less prevalent in both sexes (men: 8.9%, women: 7.1%, p = 0.15). Both prevalence and burden of DAP, AAP and TAP increased with advancing age. ConclusionNoncalcified plaque prevalence, visualized on CMR, in community-dwelling adults is similar between the sexes, and both prevalence and burden of aortic plaque increase with greater age.

Effects of Resistance Exercise, Black Maca and Combined Treatment on Blood Muscle Fatigue Factors and Muscle Function in Racket Athletes

PURPOSE: This study was conducted with racket athletes at a university to determine the effect of combination of resistance exercise and black maca for four weeks on strength and endurance of trunk muscles and fatigue-related biomarkers.METHODS: There were 16 university racket athletes classified into two groups: CO (control) (n=8) and RE (resistance exercise) (n=8). Body composition and muscle function were tested before the experiment (baseline), after four weeks (racket), and after ten weeks (racket+black maca). Before measuring body composition, we collected a blood sample to measure fatigue-related biomarkers such as myoglobin, creatine kinase (CK), lactic acid, and ammonia. Black maca was purchased from Essoco.RESULTS: In both the CO and RE groups, racket+black maca lowered blood ammonia levels compared to that at the baseline (&lt;i&gt;p&lt;/i&gt;&lt;.05) and racket (&lt;i&gt;p&lt;/i&gt;&lt;.001). There were no differences in the other fatigue-related factors. In the muscle function test, the racket+black maca increased the extension and flexion strength compared to that at the baseline (&lt;i&gt;p&lt;/i&gt;&lt;.05), while only extension strength increased after racket (&lt;i&gt;p&lt;/i&gt;&lt;.05) in the RE group. In both groups, the racket+black maca increased the extension and flexion endurance compared to that at the baseline (&lt;i&gt;p&lt;/i&gt;&lt;.05).CONCLUSIONS: Black maca intake effectively lowered the blood ammonia levels and improved muscle function. The effect on muscle function enhanced significantly when combined with resistance exercises. These results suggest that combination of black maca and resistance exercise may help improve exercise performance.

Intraorbital findings in giant cell arteritis on black blood MRI

ObjectiveBlindness is a feared complication of giant cell arteritis (GCA). However, the spectrum of pathologic orbital imaging findings on magnetic resonance imaging (MRI) in GCA is not well understood. In this study, we assess inflammatory changes of intraorbital structures on black blood MRI (BB-MRI) in patients with GCA compared to age-matched controls.MethodsIn this multicenter case-control study, 106 subjects underwent BB-MRI. Fifty-six patients with clinically or histologically diagnosed GCA and 50 age-matched controls without clinical or laboratory evidence of vasculitis were included. All individuals were imaged on a 3-T MR scanner with a post-contrast compressed-sensing (CS) T1-weighted sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) BB-MRI sequence. Imaging results were correlated with available clinical symptoms.ResultsEighteen of 56 GCA patients (32%) showed inflammatory changes of at least one of the intraorbital structures. The most common finding was enhancement of at least one of the optic nerve sheaths (N = 13, 72%). Vessel wall enhancement of the ophthalmic artery was unilateral in 8 and bilateral in 3 patients. Enhancement of the optic nerve was observed in one patient. There was no significant correlation between imaging features of inflammation and clinically reported orbital symptoms (p = 0.10). None of the age-matched control patients showed any inflammatory changes of intraorbital structures.ConclusionsBB-MRI revealed inflammatory findings in the orbits in up to 32% of patients with GCA. Optic nerve sheath enhancement was the most common intraorbital inflammatory change on BB-MRI. MRI findings were independent of clinically reported orbital symptoms.Key Points• Up to 32% of GCA patients shows signs of inflammation of intraorbital structures on BB-MRI.• Enhancement of the optic nerve sheath is the most common intraorbital finding in GCA patients on BB-MRI.• Features of inflammation of intraorbital structures are independent of clinically reported symptoms.

Deep learning-based detection algorithm for brain metastases on black blood imaging

Brain metastases (BM) are the most common intracranial tumors, and their prevalence is increasing. High-resolution black-blood (BB) imaging was used to complement the conventional contrast-enhanced 3D gradient-echo imaging to detect BM. In this study, we propose an efficient deep learning algorithm (DLA) for BM detection in BB imaging with contrast enhancement scans, and assess the efficacy of an automatic detection algorithm for BM. A total of 113 BM participants with 585 metastases were included in the training cohort for five-fold cross-validation. The You Only Look Once (YOLO) V2 network was trained with 3D BB sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) images to investigate the BM detection. For the observer performance, two board-certified radiologists and two second-year radiology residents detected the BM and recorded the reading time. For the training cohort, the overall performance of the five-fold cross-validation was 87.95%, 24.82%, 19.35%, 14.48, and 18.40 for sensitivity, precision, F1-Score, the false positive average for the BM dataset, and the false positive average for the normal individual dataset, respectively. For the comparison of reading time with and without DLA, the average reading time was reduced by 20.86% in the range of 15.22–25.77%. The proposed method has the potential to detect BM with a high sensitivity and has a limited number of false positives using BB imaging.

Comparison of imaging findings on three-dimensional black-blood enhanced MR imaging between intracranial atherosclerotic occlusion and thrombotic occlusion

PurposeThe purpose of this study was to compare the imaging findings on three-dimensional (3D) black-blood (BB) contrast-enhanced MR imaging between intracranial atherosclerotic occlusion (IAO) and thrombotic occlusion (TO) of the middle cerebral artery (MCA) territory. Materials and methodsFrom August 2020 to September 2021, we retrospectively reviewed the BB contrast-enhanced MR imaging of patients visiting the emergency room for evaluation of acute ischemic stroke. In total, 77 patients with complete occlusion of the MCA territory on 3D BB contrast-enhanced MR imaging and cerebral angiography were enrolled in this study. We divided the IAO and TO groups according to occlusion causes based on angiography findings. ResultsOf 77 patients, 44 (57.1%) had an IAO in the M1 and M2 and 33 had a TO. Lesion length contrast enhancement (CE) in patients with a TO was significantly longer than that in patients with an IAO (18.95 mm [IQR: 20.91] vs. 7.1 mm [8.92], p <0.001). Overall, 38 (39.4%) patients showed a disconnection of CE on 3D BB contrast-enhanced MR imaging, and 35 showed CE before and after the stenotic or thrombotic lesion. Symptomatic lesions on diffusion-weighted imaging in the TO group were significantly higher than that of the IAO group (97.0% vs, 70.5%, p = 0.003). ConclusionThe long segment CE on 3D BB contrast-enhanced MR imaging was related to TO of MCA. CE before and after a stenotic or thrombotic lesion is a common finding on 3D BB contrast-enhanced MR imaging.

Applying quantitative CMR parameters for detecting myocardial lesion in immune checkpoint inhibitors-associated myocarditis

PurposeSparse researches evaluated the quantitative cardiovascular magnetic resonance (CMR) parameters for immune checkpoint inhibitors (ICI)-associated myocarditis. We aimed to apply quantitative CMR mappings and late gadolinium enhancement (LGE) extent for detecting ICI-associated myocarditis. MethodThe retrospective study included patients with ICI-associated myocarditis and CMR examination from August 2018 to August 2021 in our hospital. ICI-associated myocarditis was clinically diagnosed based on the clinical criteria by European Society of Cardiology guidelines. The multiparametric CMR images including T2 mapping and black blood T2-weighted images were used to evaluate myocardial edema. The myocardial edema ratio (ER) ≥ 2.0 was applied for determining myocardial edema on T2-weighted images. Results56 patients with ICI-associated myocarditis were included. The global T2 value and native T1 value of patients with ICI-associated myocarditis were significantly higher than the reference ranges in our hospital (p < 0.05). The rate of elevated global T2 value (92%) was significantly higher than those of abnormal native T1 value (73%), ER (52%) and LGE presence (68%) in patients with ICI-associated myocarditis (p < 0.05). The LGE extent and left ventricular ejection fraction of patients with ICI-associated myocarditis were 10.38 ± 9.64% and 56.42 ± 8.54%, respectively. LGE extent inversely correlated with left ventricular ejection fraction (r = -0.38, p = 0.004) but positively correlated with native T1 value (r = 0.28, p < 0.04) and extracellular volume (r = 0.50, p = 0.001). ConclusionsT2 mapping could detect higher rate of patients with ICI-associated myocarditis than native T1 mapping, ER and LGE presence. LGE extent inversely correlated with left ventricular ejection fraction but positively correlated with native T1 value and extracellular volume in patients with ICI-associated myocarditis.

Five centuries of Cirsium ehrenbergii Sch. Bip. (Asteraceae) in Mexico, from Huitzquilitl to Cardo Santo: History, ethnomedicine, pharmacology and chemistry

Ethnopharmacological relevanceSeveral medicinal plants, including the endemic herb Cirsum ehrenbergii (Asteraceae), have been documented in manuscripts, medical and botanical books written in Mexico since the XVI century until the present. This unique circumstance is a real window in the time that allows to investigate historical and contemporary ethnopharmacological knowledge. Aim of the studyTo examine the persistence, disappearance, and transformation of ethnomedicinal knowledge of C. ehrenbergii along time. Also, to investigate the chemistry and pharmacology of this species in relation to its historical and present day main ethnomedical applications related to Central Nervous System and inflammation. Materials and methodsA thorough review was performed of written sources of medicinal plants from XVI and onwards. For the pharmacological studies, the organic extracts were tested in mice models to assess its antidepressant and anti-inflammatory properties. The active extracts were studied chemically. The isolated compounds were identified by 1H, 13C NMR, or characterized by GC-MS. ResultsCirsum ehrenbergii was illustrated for the first time (1552) in the Libellus de Medicinalibus Indorum Herbis (Booklet of Medicinal Plants of the Indians) and named in the Nahuatl native language as huitzquilitl (edible thistle). It was there recommended as nigris sanguinis remedium (remedy for black blood), and for the treatment of illnesses with an inflammatory component. Nigris sanguinis was well known in the European medicine of that time and currently it has been interpreted as “depression”. At the present time, peasants and native population in Mexico mainly name C. ehrenbergii in Spanish as cardo Santo (holy thistle). Its original Nahuatl name has been almost forgotten. However, these communities use this species, among other maladies, to heal “nervios” (anxiety and/or depression) and for anti-inflammatory purposes. These ailments and treatments resemble those recorded in the Libellus and in several medicinal plant books along centuries.The ethanol extract of C. ehrenbergii roots showed antidepressant-like activity in mice administered at 300 mg/kg, as indicated by the forced swim test (FST). The glycosylated flavonoid linarin was identified as antidepressant principle and was active at the doses of 30 and 60 mg/kg in the FST. Regarding to anti-inflammatory activity, the most active was the methylene chloride extract of the aerial parts, which contains taraxasterol, pseudotaraxasterol, β-sitosterol and stigmasterol. ConclusionsCirsium ehrenbergii extracts possess antidepressant-like (roots, EtOH) and anti-inflammatory (aerial parts, CH2Cl2) properties, containing active compounds. Our results sustain historical and present day ethnomedical applications of this species documented along five centuries.

The Sound of Navajo Country: Music, Language, and Diné Belonging

The Sound of Navajo Country: Music, Language, and Diné Belonging